- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.71 / $1.71 / $4.45
| Facility | | $1.71 | $1.71 | $4.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.71 / $1.71 / $1.93
| Professional | | $1.71 | $1.71 | $1.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.71 / $1.71 / $3.90
| Professional | | $1.71 | $1.71 | $3.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.77 / $1.77 / $1.77
| Facility | | $1.77 | $1.77 | $1.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.77 / $1.77 / $1.77
| Professional | | $1.77 | $1.77 | $1.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.61 / $1.61 / $1.87
| Facility | | $1.61 | $1.61 | $1.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.71 / $1.71 / $2.15
| Professional | | $1.71 | $1.71 | $2.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.61 / $2.42 / $332.00
| Facility | | $1.61 | $2.42 | $332.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.58 / $1.86 / $1.86
| Professional | | $1.58 | $1.86 | $1.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.71 / $1.71 / $1.78
| Facility | | $1.71 | $1.71 | $1.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.71 / $1.71 / $1.78
| Professional | | $1.71 | $1.71 | $1.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.61 / $1.71 / $555.00
| Facility | | $1.61 | $1.71 | $555.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.71 / $1.86 / $2.42
| Professional | | $1.71 | $1.86 | $2.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.71 / $1.71 / $2.96
| Professional | | $1.71 | $1.71 | $2.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.78 / $1.78 / $5.87
| Facility | | $1.78 | $1.78 | $5.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.71 / $1.78 / $5.64
| Professional | | $1.71 | $1.78 | $5.64 |